A patient post knee arthroplasty is complaining of tingling in the surgical leg. What should be the nurse's first priority?

A. Encouraging deep breathing exercises:While deep breathing is generally helpful, it may be difficult for a patient with emphysema who suffers from air trapping. Without proper positioning, these exercises may not be enough to overcome the mechanical disadvantage of a flattened diaphragm. It is a secondary supportive measure for pulmonary hygiene.

B. Restricting fluid intake:Fluid restriction is not indicated for emphysema unless the patient has developed secondary right-sided heart failure. In fact, adequate hydration is usually encouraged to keep secretions thin and easy to expectorate. Restricting fluids without a specific cause could lead to thickened mucus and worsening obstruction.

C. Positioning the patient in high Fowler's:Elevating the head of the bed to 60 to 90 degrees allows for maximum diaphragmatic excursion and chest expansion. This position uses gravity to pull the abdominal contents downward, reducing pressure on the lungs and improving the efficiency of gas exchange. It is the most effective immediate non-pharmacological intervention.

D. Administering bronchodilators:These medications help open the airways but may not be enough to resolve acute hypoxemia if the patient's positioning is poor. While they are a vital part of the pharmacological regimen, they work best when combined with optimal positioning. Positioning provides an immediate mechanical advantage for ventilation.

A. Check the neurovascular status of the affected limb:Tingling, or paresthesia, is one of the "six Ps" of neurovascular compromise and can indicate nerve compression or compartment syndrome. The nurse must immediately assess pulses, sensation, and capillary refill to ensure limb viability. This physical assessment takes priority over pharmacological or comfort measures.

B. Administer pain medication:While the patient may be in discomfort, administering analgesics without a thorough assessment could mask symptoms of serious complications. Paresthesia is distinct from nociceptive pain and requires a different diagnostic focus. Safety must be established through assessment before symptomatic treatment is initiated.

C. Notify the orthopedic surgeon immediately:Communication with the surgeon is necessary, but the nurse must first collect objective data to provide a comprehensive report. Immediate notification without an assessment prevents the surgeon from making an informed decision about the urgency of the intervention. Assessment must precede notification in clinical workflows.

D. Apply ice to the operative site:Cryotherapy is used to reduce swelling and provide localized analgesia. However, if the tingling is caused by excessive pressure from a dressing or internal swelling, ice will not resolve the underlying nerve compression. It is a supportive measure that follows a definitive neurovascular evaluation.